Nurse practitioners vs. general practitioners

One of the key problems in medicare today is the lack of primary care. Many illnesses are not treated early enough; many people are not seen frequently enough to maintain a good standard of care. Needless to say this is also much cheaper to treate early. The main problem is that there is a lack of primary care physicians – family doctors. Why? Well, for an extra year or two of schooling, a specialist can make 50-100% more money a year. The benefits of family care — long-term tracking, good hours, interaction with patients — don’t compensate for this. The OMA would have us believe the solution is to increase the salaries of family physicians. That might work, but it might not.

I think the solution is to turn the model on its head. The primary care problem is one of care. The provider should be someone who provides health ‘care’ for a person over a long period of time. But doctors are trained to cure, to fix problems, usually short-term. So who provides care? Nurses, of course. I propose we make nurses the chief providers of primary care.

Is the skillset of a primary care provider significantly more advanced than a registered nurse? I don’t believe so. My own experience is that the chief requirements in a primary care provider is the ability to understand when they are out of their depth, and good diagnostic ability. The first, so that they can refer to a specialist; the second, so they can prescribe further treatment – scans, drugs, tests, etc. The rest is relatively trivial, medically speaking: wound dressing, annual checkups, follow-ups. Why should this set of skills be the same as those given to someone who is going to deliver trauma care, or perform cardiac surgery? We are wasting education dollars on general practitioners.

My proposal is to train in two streams. Medical schools would continue the four year program. At the end of that, a student is qualified to become a primary care provider, once a one year internship has been followed (perhaps a short series of rotations). Other students can continue on as before in specialty training. The other stream is the nursing school. A nurse receives a BScN and RN designation as currently happens. Then, following one year of practice, he/she is eligible to train for a further two years as a nurse practitioner. After that, and the same one year internship, he/she is ready to become a primary care provider.

Published in: on November 9, 2006 at 8:30 pm  Leave a Comment  

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